Elsevier

Social Science & Medicine

Volume 224, March 2019, Pages 23-27
Social Science & Medicine

Short communication
Accepters, fence sitters, or rejecters: Moral profiles of vaccination attitudes

https://doi.org/10.1016/j.socscimed.2019.01.038Get rights and content

Highlights

  • Parents completed a vaccine confidence inventory and a measure of moral preferences.

  • We applied latent profile analysis to responses on the vaccine confidence inventory.

  • Three profiles of parents were uncovered: accepters, fence sitters, and rejecters.

  • The three profiles were associated with different moral preferences.

  • Fence sitters and rejecters both exhibited strong moral concerns for liberty.

Abstract

Rationale

Childhood vaccination is a safe and effective way of reducing infectious diseases. Yet, public confidence in vaccination is waning, driven in part by the ‘manufacture of doubt’ by anti-vaccination activists and websites. However, there is little research examining the psychological underpinnings of anti-vaccination rhetoric among parents.

Objectives

Here, we examined the structure and moral roots of anti-vaccination attitudes amongst Australian parents active on social media parenting sites.

Methods

Participants (N = 296) completed questionnaires assessing their vaccination attitudes, behavioural intentions, and moral preferences.

Results

Using Latent Profile Analysis, we identified three profiles (i.e., groups), interpretable as vaccine “accepters”, “fence sitters”, and “rejecters”, each characterised by a distinct pattern of vaccination attitudes and moral preferences. Accepters exhibited positive vaccination attitudes and strong intentions to vaccinate; rejecters exhibited the opposite pattern of responses; whilst fence sitters exhibited an intermediate pattern of responses. Compared to accepters, rejecters and fence sitters exhibited a heightened moral preference for liberty (belief in the rights of the individual) and harm (concern about the wellbeing of others). Compared to acceptors and fence sitters, rejecters exhibited a heightened moral preference for purity (an abhorrence for impurity of body), and a diminished moral preference for authority (deference to those in positions of power).

Conclusion

Given the sensitivity of fence sitters and rejecters to liberty-related moral concerns, our research cautions against the use of adversarial approaches—e.g., No Jab, No Pay legislation—that promote vaccination uptake by restricting parental freedoms, as they may backfire amongst parents ambivalent toward vaccination.

Introduction

Childhood vaccination is one of the most important public health achievements of the last century. However, in recent years many countries have faced growing problems with vaccine hesitancy: “the delay in acceptance or refusal of vaccination despite availability of vaccination services” (MacDonald, 2015). While there is generally a high rate of vaccination coverage in most western developed countries, clusters of under-vaccinated individuals have now contributed to outbreaks of diseases previously considered eradicated or controlled (Shetty, 2010). Furthermore, even among parents who do choose to vaccinate their children, there is a growing number who express doubts and concerns about vaccination (Kennedy et al., 2011).

While the reasons for the decline in public confidence surrounding vaccination are many, one major contributor is the communication of misinformation by a small yet vocal anti-vaccination movement (Betsch et al., 2010; Dubé et al., 2014). Amongst some sections of the general public, the impact of such misinformation has been to foster misperceptions about vaccine facts and risks, and the discounting of vaccine expertise (Benegal, 2018; Motta et al., 2018). Much work has analysed the specific arguments commonly employed by online anti-vaccination activists, demonstrating that opposition to childhood vaccination is situated in the following discourses: (1) vaccination is ineffective and unsafe, (2) vaccination is a governmental intrusion into parental autonomy, (3) vaccines are unnatural, and alternative, natural lifestyles provide sufficient protection against infectious disease, and (4) the safety and effectiveness of vaccination is subject to sinister cover ups by the government and pharmaceutical companies (Kata, 2010, 2012). While the information that tends to be proffered on anti-vaccination websites is well understood, two important questions remain.

First, it is unclear the extent to which the specific arguments employed by online anti-vaccine activists are endorsed among a broader population of parents. It is commonly assumed that there exist multiple types of parents who differ in their vaccination beliefs and behaviours. Although many researchers argue for such a distinction, thus far, vaccine hesitancy has typically been plotted along a single continuum (Opel et al., 2011). Indeed, there is little quantitative research examining whether there exist distinct types of parents who differ in the extent to which they endorse anti-vaccination beliefs. Of the existing studies, most have uncovered at least three kinds of parents: (1) a small yet vocal group of outright vaccine rejecters who oppose the use of vaccines in all forms, and a potentially larger group of (2) fence sitters, characterised by uncertainty and a lack of confidence in vaccines, but who may still support vaccination in some respects, and (3) vaccine accepters who strongly endorse vaccination practices (Larson et al., 2014). Here, we examined the core attitudes and beliefs that comprise opposition to vaccination typically promoted by anti-vaccine activists online. We hypothesised that there would be at least three distinct profiles of parents representing strong, intermediate, and weak support of anti-vaccination beliefs.

Second, there is little work examining the psychological variables that may underpin objection to vaccination. There is agreement in the literature that opposition to vaccination—particularly in its most extreme form—likely stems from strongly held ideological beliefs (Dubé et al., 2014; Leask, 2015) and conspiracist ideational tendencies (Lewandowsky et al., 2013). This can perhaps explain why attempts to correct vaccine misinformation can sometimes be counterproductive: although corrections reduce—but do not eliminate—belief in vaccine misinformation, paradoxically they can reduce intentions to vaccinate amongst certain groups (Nyhan et al., 2014; Nyhan and Reifler, 2015). Such “backfire effects” (cf. Rossen et al., 2016) are likely to materialise when the corrective information is at variance with the message recipient's cultural and moral values. For example, there is evidence that resistance to some vaccines is driven by a specific form of motivated reasoning (Kunda, 1990)—known as identity protective cognition—wherein beliefs that align with the moral values of one's cultural in-group are accepted, whereas those that clash are rejected (Kahan, 2013; Kahan et al., 2010). However, to date there has been no attempt to elucidate the nature of the moral values associated with vaccine hesitancy, which may be a necessary route to crafting persuasive communications that resonate with vaccine-hesitant parents.

To plug this theoretical gap, in the current paper we apply Moral Foundations Theory, which proposes six core moral domains upon which people differentially base their morality. The foundations are: harm (concerned with violations to the safety and wellbeing of others), fairness (concerned with the pursuit of justice), in-group (favouring one's in-group first), authority (a preference for traditional societal structures and deference to those in positions of power), purity (an abhorrence for impurity of body or mind and ‘unnatural’ acts), and liberty (a preference for freedom and the rights of the individual) (Haidt and Joseph, 2004, 2008; Iyer et al., 2012). Multiple lines of evidence indicate that people's stances on a number of culturally divisive issues can be explained in part by their ‘moral profile’, as defined by their position along these six moral foundations (Feinberg and Willer, 2013; Koleva et al., 2012; Rossen et al., 2015)—although see Smith et al. (2017) for important methodological limitations of Moral Foundations Theory.

We suggest that individual differences in endorsement of the moral foundations may shed light on why some people are opposed to vaccination. We made some broad hypotheses about the moral foundations likely to be associated with opposition to vaccination. First, we hypothesised that support of the moral foundation harm may be an important driver of opposition to vaccination because the belief that vaccines are harmful and unsafe may stem from a heightened sensitivity toward harm violations. Liberty is likely implicated in the decision to not vaccinate a child, given the potential for vaccination to be viewed as government intrusion into parental autonomy through schemes such as No Jab, No Pay and No Jab, No Play (Beard et al., 2017). Purity is also likely relevant given the perception that vaccination is “unnatural”. Finally, we suggest that authority may be inversely associated with endorsement of anti-vaccination beliefs, given the perception that regulatory bodies conceal information about the safety and effectiveness of vaccination from the public.

In sum, it is currently unclear whether (1) there are distinct types of parents who vary in their support of anti-vaccination rhetoric, and (2) whether a unique pattern of moral values underpins these distinct types of parents. To investigate these questions, we constructed a novel 18-item measure to tap into the most common beliefs that are featured on anti-vaccination websites. We administered this novel inventory and the Moral Foundation Questionnaire, which measures the six moral foundations, to a self-selected sample of denizens of Australian online parenting forums within which both pro- and anti-vaccination sentiments existed. As anti-vaccination and vaccine-hesitant parents represent a small minority of the population, this opportunistic sample afforded us the chance to obtain relatively large numbers of these parents, so as to construct a more accurate picture of their underlying moral profiles.

Section snippets

Methods

Ethical approval to conduct the study was granted by the Human Research Ethics Office at the University of Western Australia (RA/4/1/6723).

Australian visitors to parenting websites who self-identified as a parent or guardian voluntarily completed an online questionnaire between May and December 2014 (N = 296; 85.4% female; mean age = 35.33, SD = 8.31). The survey link was posted on six parenting forums and Facebook pages on which community members expressed a diverse range of attitudes on

Results

Our first aim was to investigate the emergence of profiles, or constellations of attitudes towards vaccination and, accordingly, we employed person-centred analytical methods. To this end, we undertook Latent Profile Analysis (LPA) with Mplus 7.3 using robust maximum likelihood estimation, specifying models with one, two, and finally, three profiles (see supplemental materials for technical details and model fits).

Overall, we found that the three-profile model offered substantially improved fit

Summary of results

The research reported here contributes the first quantitative psychological investigation of the structure of endorsement of anti-vaccination rhetoric among parents—specifically, Australian parents active on social media parenting sites. We make two important contributions. First, we constructed an inventory specifically designed to tap into the most common beliefs that form the basis of the anti-vaccination movement. Second, we used this inventory to examine whether there are distinct types of

Author note

Isabel Rossen, Mark J. Hurlstone, Patrick D. Dunlop, and Carmen Lawrence: School of Psychological Science, University of Western Australia. The first two authors contributed equally to the work reported here. Correspondence concerning this article should be addressed to Mark Hurlstone, School of Psychological Science, University of Western Australia, Crawley, WA 6009, Australia.

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